Individual ProviderNicholas Joseph TalleyInternal MedicineAllopathic & Osteopathic PhysiciansPractice Address4500 San Pablo Rd S, Jacksonville, FL 32224-1865(904) 953-2000PECOS EnrollmentBased on the most recent information from CMS, provider Nicholas Joseph Talley does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 12:57 PM.Profile DetailsProvider ID1003895632Provider TypeIndividualFull NameTalley, Nicholas JosephCredentialM.D.GenderMaleSole ProprietorNoEnumeration Date1/12/2006Last Updated6/26/2009Contact InformationPractice LocationPractice Address4500 San Pablo Rd S, Jacksonville, FL 32224-1865Phone(904) 953-2000FaxUnlisted FaxMailing LocationMailing Address4500 San Pablo Rd S, Jacksonville, FL 32224-1865Phone(904) 953-2000FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode207RG0100XPrimaryDescriptionInternal MedicineAllopathic & Osteopathic PhysiciansLicenseMFC1616FloridaCode207RG0100XDescriptionInternal MedicineAllopathic & Osteopathic PhysiciansLicense32557MinnesotaProvider IdentifiersIDDescriptionIssuerID416318400DescriptionMedicaidIssuerUnlistedMinnesota